MEDICAL CERTIFICATE OF FITNESS FOR COMPETITIVE SPORTS

MEDICAL CERTIFICATE OF FITNESS FOR COMPETITIVE SPORTS

70 Van Dyke street,
Brooklyn, New York
11231 USA
[email protected]
MEDICAL CERTIFICATE OF FITNESS FOR COMPETITIVE SPORTS
(to be presented at the riders check-in desk in Milano)
PLEASE USE BLOCK LETTERS ONLY
I, Dr. (Name, Surname)
________________________________________________________________________________________________
HEREBY STATE THAT
Mr. / Mrs / Ms (Name, Surname)
________________________________________________________________________________________________
born (City, Country)
________________________________________________________________________________________________
on (dd/mm/yyyy)
______ / ______ / _________
and resident at (address, city, country)
________________________________________________________________________________________________
According to the results of medical check ups and examinations is currently healthy and fit to
participate in competitive cycling events and in particular Red Hook Criterium Milano Nº 6
.
Date (dd/mm/yyyy)
______ / ______ / _________
Doctor's signature and stamp _______________________________________
NOTE! If possible, please also send a copy of this certificate via e-mail to
[email protected] to speed up the accreditation process.
The original copy of this certificate must be presented to the riders check-in desk in
Milano.